Hierarchical associations with care-seeking delay in patients with heart failure: A network analysis

This study aimed to explore the factors associated with care-seeking delay in patients with heart failure through network analysis.

In this cross-sectional study, a total of 313 patients with heart failure were recruited from three cardiovascular departments of a tertiary general hospital in China between February and December 2023. Self-reported questionnaires were used to measure sociodemographic characteristics, attitudes toward seeking medical care, stigma, medical resources accessibility, symptom characteristics, and perceived barriers to health care-seeking decision. Binary logistic regression analysis and network analysis were performed to identify factors associated with care-seeking delay.

The median delay time was 116 h. Accordingly, 156 (49.8%) patients with heart failure were classified as having delayed care-seeking. In the network model, hierarchical pattern of associations with care-seeking delay was observed. Symptom tolerability (weight = 0.691) and symptom frequency (weight = 0.670) exhibited high correlations with care-seeking delay. Attitude toward seeking medical care (weight = 0.479) demonstrated a moderate correlation with care-seeking delay. Female (weight = 0.284), stigma (weight = 0.210), and perceived barriers to health care-seeking decision (weight = 0.279) showed relatively weak correlations with care-seeking delay.

Care-seeking delay is common in patients with heart failure. Female, negative attitudes toward seeking medical care, higher levels of stigma, tolerable and intermittent symptoms, and increased perceived barriers to health care-seeking decision are associated with care-seeking delay, with tolerable and intermittent symptoms emerging as central nodes. These findings suggest that interventions targeting patients' symptom perception and appraisal may be particularly promising in reducing care-seeking delay.